EFFECT OF MULTIVITAMIN SUPPLEMENTATION ON MEASLES VACCINE RESPONSE AMONG HIV-EXPOSED UNINFECTED TANZANIAN INFANTS.

Monday, 7th of July 2014

[source]Clinical and Vaccine Immunology[|source]

Immunization and nutritional interventions are the foundation for most child health programs worldwide, yet limited data are available on the interaction between vaccine responses and nutrition.  The effect of vitamin A on measles vaccine responses has been studied in multiple clinical trials, but the results are unclear, as Vitamin A has been documented to improve measles vaccine responses among boys when administered with the vaccine at 9 months of age and worsened responses when administered at 6 months of age.

 

In this report, the authors tested the hypothesis that multivitamins containing vitamins B complex, C, and E provided to HIV-exposed infants would increase measles IgG quantity and avidity compared to a placebo. The authors included HIV-infected infants in the trial as a secondary comparison group to determine the effectiveness of measles vaccination in this population. The report documents that supplementation with multivitamins containing B complex, C, and E appears to improve measles vaccine responses for HIV-exposed infants, before calling for further studies  to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants. More details are accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754503/

 

ABSTRACT

Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses.